Abstract
Home-visiting support during pregnancy or soon after the birth of an infant can be advantageous for maternal well-being and infant development. The best results have been identified when home visitors are professionals, especially nurses, and if a theoretically driven curriculum is followed with fidelity. Some suggest that disadvantaged families, who may avoid professional services, respond well to support from community volunteers, but there is less evidence about their impact. This study identified potentially vulnerable mothers during pregnancy in randomly allocated neighbourhoods where local volunteer home-visiting schemes agreed to offer proactive volunteer support and control areas where the local home-visiting schemes did not offer this proactive service. Taking demographic, child, and family factors into account, there were no significant differences in infant cognitive development at 12 months of age between families who had been supported by a volunteer and those who had not. Better cognitive development was predicted by less reported parenting stress when infants were 2 months and a more stimulating and responsive home environment at 12 months. The results suggest that unstructured proactive volunteer support for potentially vulnerable families is not likely to enhance infant development. Limitations of the cluster-randomised design are discussed.
Highlights
Based on evidence from studies of early brain development (e.g., [1, 2]) and interventions in the USA such as Early Head Start [3], there has been an increasing emphasis in the UK on offering early intervention designed to enhance infant development and increase family well-being, especially to disadvantaged families [4, 5]
Families in the control group and those in intervention areas offered but not receiving Home-Start received existing services provided by the UK National Health Service (NHS) free of charge to all mothers and infants, that is, home visits from a midwife are routine during pregnancy, and for two weeks after the birth, home visits are routine from a health visitor after the child’s birth; there is on-going availability of their general practitioner (GP) and, when referred by the GP, from any of the specialist mental health services [41]
More than half of the support (56%) had started by the infant’s birth, and almost all families (93%) were receiving support when the first research home visit was made and when infants were 2 months old meaning that the family characteristics such as reported stress, the home environment, and maternal depression and child characteristics such as difficult temperament may have been influenced by the support
Summary
Based on evidence from studies of early brain development (e.g., [1, 2]) and interventions in the USA such as Early Head Start [3], there has been an increasing emphasis in the UK on offering early intervention designed to enhance infant development and increase family well-being, especially to disadvantaged families [4, 5]. The combination of both home-based visits and centre-based services can be effective, such as the Infant Health and Development Programme in the USA which was offered in the context of a randomised control trial to parents of low-birth-weight infants (e.g., [12]) Such comprehensive experimental programmes are generally too costly to incorporate into existing services. In a review of parenting support, Moran et al [17] categorised support as informal (neighbours, family), semiformal (community organisations, the voluntary sector), and formal (professional services) Both Moran et al [17] and a more recent review [18] concluded that formal interventions with a strong theory base and a clearly articulated model may be the most effective, with the most potential to influence child outcomes. This study was designed to determine if volunteer support offered prior to or soon after an infant’s birth could have a positive impact on child development when infants were 12 months of age
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